{"id":11397,"date":"2011-09-21T11:00:25","date_gmt":"2011-09-21T10:00:25","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=11397"},"modified":"2012-03-30T13:43:04","modified_gmt":"2012-03-30T12:43:04","slug":"richard-smith-un-meeting-on-ncds-day-two","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2011\/09\/21\/richard-smith-un-meeting-on-ncds-day-two\/","title":{"rendered":"Richard Smith: UN meeting on NCDs &#8211; day two"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/site\/blog\/icons\/bmjh7648e.jpg\" alt=\"Richard Smith\" width=\"160\" height=\"110\" align=\"left\" \/><strong>Tuesday 20 September. Day two<\/strong><br \/>\n<strong>7.10<\/strong> Traffic is gridlocked near the UN building because so many streets are shut. Obama hits the UN today\u2014not unfortunately the NCD meeting.<!--more--><\/p>\n<p><strong>7.35<\/strong> I arrive at the UK Mission to the UN. \u201cI work in the mission,\u201d a woman tells me, \u201cI know it sounds silly.\u201d I can\u2019t stop myself singing \u201cWill you come to the mission, will you come?\u201d The woman from the mission negotiated the NCD declaration on behalf of the UK government and said that she was surprised that it was more controversial than the AIDS declaration. The arguments were over targets, resources, and TRIPS.<br \/>\nI say that I\u2019m taken aback by the UN process. \u201cSo was I when I arrived,\u201d she says. \u201cIf you want fast results don\u2019t go in for diplomacy. This is a glacial game. But things do change. We\u2019re debating women\u2019s rights in a way that was impossible 20 years ago and gay rights in a way that was impossible five years ago. I love that the Sudan must talk on what it\u2019s doing about women\u2019s rights in the same meeting as Norway, and I love Robert Mugabe talking about what he\u2019s doing about NCDs. Everybody in the room knows he\u2019s lying.\u201d<\/p>\n<p>8.00 The side meeting on patient empowerment sponsored by BUPA and the George Institute begins. Patient empowerment is not a nice to have it\u2019s a must have, says Anne-Marie Feyer of the George Institute. We need to build it into health system, operationalise it. She is launching a report on patient empowerment and NCDs. http:\/\/www.bupa.com\/chronicdiseasereport<\/p>\n<p><strong>8.10 <\/strong>Real patient empowerment can improve quality and cut costs, says David Wennberg from Bupa. A study in Health Affairs of patients who had undergone nine common procedures\u2014like hip replacement\u2014showed that they hadn\u2019t received half of the information they should have received. \u201cIt\u2019s really embarrassing,\u201d says Wennberg, \u201cbut many patients don\u2019t know that they have a choice. They think that they just have to do what the doctor says.\u201d An RCT of 170 000 patients published in the New England Journal of Medicine in September showed that patients intensely supported with decision aids had 10% fewer admissions to hospital and costs that were 3.5% lower.<\/p>\n<p><strong>8.15<\/strong> Rushika Fernandapulle of IORA Health reminds us that patients with NCDs spend two hours a year with health professionals and\u00a0 8758 hours (more in a leap year) without. Of course they have to be in charge. He describes how his company redesigned the health system for casino workers in Atlantic City to make patient empowerment central. All patients have a personal health provider who comes from their community and advises them on all choices. Technology and data analysis underpin the redesigned system. The result was an increase in primary care and drug costs (because patients took their drugs) but hospital admissions went down by 40% and costs by 15%. (Are these results possible only in an excessive health care system like the US, I ask later. The point is not necessarily to cut costs but to empower patients because it\u2019s the right thing to do and to get more benefits from the system, says Feyer.<\/p>\n<p><strong>8.20<\/strong> I\u2019ve hardly heard patients mentioned at the NCD meeting, said Eva Maria Lopez from the International Alliance of Patients Organisations.<\/p>\n<p><strong>8.50<\/strong> \u201cWe tried to get patient empowerment into the UN declaration but the developing countries didn\u2019t want it,\u201d says the woman from the mission.<\/p>\n<p><strong>8.55 <\/strong>A doctor tells us that medical students at Georgetown University have to make a personal change\u2014lose weight or stop smoking. They find it hard.<\/p>\n<p>9.10 I hear that the NCD meeting has bee extended by two hours because 136 countries want to speak. And the meeting has evidently been attended by some 34 heads of state, more than for the AIDS meeting.<\/p>\n<p><strong>9.30<\/strong> The BUPA meeting ends after the usual confused but occasionally interesting conversation. The conclusion is \u201cDon\u2019t just talk about patient empowerment. Start doing, experimenting, evaluating, and making changes as necessary.\u201d<\/p>\n<p><strong>9.35<\/strong> That\u2019s the end of the UN meeting for me. I have no tickets for today, and I\u2019m certainly not going to watch the webcast. Has it been a success? The meeting itself, I now understand, is a ritual. The horse trading went on before the meeting, and the declaration has something for everybody\u2014too much, I\u2019d say. There may be no targets, but could we set realistic targets at this stage when global surveillance data are so weak? The now familiar phrase of \u201call of government and all of society\u201d is a good one that has helped people understand that a response from only the health system will be hopeless. There is a proposal for creating a global plan, and it\u2019s more realistic to do it over the next year or two than to have thrown it together in the past year. Consciousness has been raised, new data have been released, and one of the biggest benefits has been the creation of the NCD Alliance, which now has 2000 members.<br \/>\nThe big failures for me have been the failure to raise understanding of NCDs among the wider population and\u2014as discussed at this morning\u2019s meeting\u2014the failure to recognise the need for a system that has at its centre patients not professionals.<\/p>\n<p><em><strong>Richard Smith<\/strong> was the editor of the <\/em>BMJ<em> until 2004 and is director of the United Health Group&#8217;s chronic disease initiative.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tuesday 20 September. Day two 7.10 Traffic is gridlocked near the UN building because so many streets are shut. Obama hits the UN today\u2014not unfortunately the NCD meeting. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2011\/09\/21\/richard-smith-un-meeting-on-ncds-day-two\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38364,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[955],"tags":[322,304,2568],"class_list":["post-11397","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-smith","tag-non-communicable-diseases","tag-public-health","tag-un-summit"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Richard Smith: UN meeting on NCDs - day two - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2011\/09\/21\/richard-smith-un-meeting-on-ncds-day-two\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Richard Smith: UN meeting on NCDs - day two - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Tuesday 20 September. 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